Method for diagnosis of and therapy for a subject having a central nervous system disorder

ABSTRACT

A method is provided of systematically evaluating and treating dynamic autonomic dysregulation in a subject. The method includes having the subject sequentially assume a plurality of distinct postures that may include, for example, walking, standing, sitting or supine. In each posture of the subject, the subject is subjected to sensory stimulation while measuring at least one autonomic physiological response of the subject. The autonomic physiological response may include, for example, oxygen saturation, heart rate, pupillary response, blood pressure, sweat production, pseudomotor activity or respiration. The physiological responses in each of the distinct postures are evaluated to identify a posture wherein the subject exhibits a least amount of dysfunction.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation of prior U.S. application Ser. No.14/033,004, filed Sep. 20, 2013, which claims the benefit of U.S.Provisional Application 61/726,511, filed Nov. 14, 2012. The contents ofthese prior applications are incorporated herein by reference in theirentirety.

TECHNICAL FIELD

The present invention relates to an apparatus and method for diagnosisof and therapy for a subject having a disorder of the central nervoussystem, and more particularly to providing CNS therapy through ajudicious combination of a subject's posture and environmental stimuli.

BACKGROUND ART

It is known in the prior art that brain injury is one the leading causesof disability. In addition to the obvious, highly visiblevictims—returning soldiers and those who have suffered strokes—it isreported that a very high percentage of today's prison inmates have someform of brain injury related impairment. The advanced training andmethods of first responders and emergency departments has led to a muchgreater rate of surviving a major traumatic head/brain injury. Adding tothis population are children and young adults who have suffered sportsrelated head injuries, as well as violence/abuse related brain injury.Another population affected by brain injury/dysfunction are those withdevelopmental disorders and learning disabilities. Whether the etiologyof this dysfunction is genetic, congenital or environmental, it stillmanifests an underlying brain function anomaly. These disorders can becombined with traumatically acquired brain injury and therefore greatlycompound the overall impairment. Many of these injuries result inlasting changes in memory, computational, emotional, as well asautonomic function. It is reported that unemployment among thispopulation is disproportionately high, and some find it impossible tomaintain employment, even with placement, due to their cognitiveimpairments.

The diagnosis and treatment of brain-based lesions have been extremelydependent upon the geographic location and the particular facilitywithin that location where treatment is sought. The choice ofintervention and which treatment protocols that are followed are basedlargely upon the traditions and practices of the particular therapistsand doctors who compose the patient's treatment team. Frequently inthese cases, only the life threatening aspects of the disorder/injuryare addressed, neglecting soft or ‘functional/physiological’ lesions,even if an extensive rehabilitation regimen is undertaken. It is awidely held belief in social work, cognitive rehabilitation andnutritional counseling, but not consistently implemented, that—oncestabilization has occurred following post-neurosurgical, traumatic,acquired brain injury, or even developmental, disorders and learningdifficulties have manifested—therapy directed at producing lastingchange to the structural and functional integration should be a majorportion of any rehabilitation process.

Moreover, there is a functional and spatial mapping between differentareas of the brain and different areas of the body. For example, thebody includes afferent nerves that carry sensory signals to the centralnervous system, including the state of smooth muscle contraction inarteries, the amount of local blood flow to an area, local temperature,the presence of chemistry related to tissue injury, and pH, O2, and CO2levels. By contrast, efferent nerves carry motor signals from thecentral nervous system to the muscles. These two types of nerves servedifferent purposes, and are located in different places within thebrain. Injuries to different parts of the brain therefore sometimesmanifest themselves as dysfunction of different areas of the body,either as diminished sensory capability or as diminished motorcapability.

Small diameter afferent fibers consist of Type C and Aδ peripheral nervefibers. These are thin, unmyelinated, and slow conducting in nature. Theinformation they relay includes the state of smooth muscle contractionin arteries, the amount of local blood flow to an area, localtemperature, the presence of chemistry related to tissue injury, and pH,O2, and CO2 levels. Type 2 C fibers are strongly activated bynon-painful cold and heat stimulation. These fibers converge onto theVMpo thalamic nucleus, and by way of the NTS and PB (Parabrachial)nucleus, onto the VMb thalamic nucleus. The VMpo thalamic nucleus fibersconnect onto the anterior and posterior insular neural maps. Fibers fromthe VMb thalamic nucleus synapse onto the posterior insular cortex.

Using traditional treatment methods for chronic pain have had pooroutcomes, especially if the pain is caused by a sympathetic nervoussystem disorder that can be exacerbated by a wide variety of unrelatedtriggers such as food and weather. Some individuals may simply cope withthe pain, traveling from doctor to doctor, never getting an accuratediagnosis, being told that their pain is “all in their head”. One suchdisorder is reflex sympathetic dystrophy (RSD) syndrome, also known ascomplex regional pain syndrome (CRPS). RSD has no known cause and noknown cure.

SUMMARY OF THE EMBODIMENTS

Various embodiments of the invention described herein recognize thatdifferent body postures affect the autonomic nervous system differently,and therefore various external stimuli may have different therapeuticefficacies when a patient or subject is in each body posture. Postures,such as walking, sitting, standing, and supine, have different effectson the autonomic nervous system, and therefore some stimuli havedifferent physiological efficacies while a patient or subject is in agiven body posture. Disclosed embodiments of the present inventionleverage this relationship to determine a combination of posture andstimulus that has optimal therapeutic effect. These embodiments providea treatment that stimulates the nervous system through a combination ofnoninvasive therapies that stimulate brain cells to increase theirefficiency—this promotes the formation of pathways that help transferinformation throughout the brain in such a way that in the end, theaffected area of the brain and overall brain function are improvedwithout medication or surgery. Indeed, the autonomic responseadvantageously may be addressed as the first step in the examination andrehabilitation process. Is further noted that, while a treatment mayalleviate some symptoms of an underlying disability or illness, such ascomplex regional pain or RSD, it might not cure all the causes of theillness. Further embodiments thus provide for reevaluating theoptimality of the posture/stimulus combination once relative normalcyhas been achieved with respect to a given monitored physiologicalresponse, to determine whether any residual dysregulation remains.

In accordance with an embodiment of the invention, there is provided amethod of systematically evaluating dynamic autonomic dysregulation in asubject. The method includes having the subject sequentially assume aplurality of distinct postures that may include, for example, walking,standing, sitting or supine. In each posture of the subject, the subjectis subjected to sensory stimulation while measuring at least oneautonomic physiological response of the subject. The autonomicphysiological response may include, for example, oxygen saturation,heart rate, pupillary response, blood pressure, sweat production,pseudomotor activity or respiration. The physiological responses in eachof the distinct postures are evaluated to identify a posture wherein thesubject exhibits a least amount of dysfunction.

In accordance with related embodiments of the invention, subjecting thesubject to sensory stimulation may include subjecting the subject to astimulus selected from the stimulus group consisting of TENS,non-painful heat, non-painful cold, visual, occulomotor stimulation,crude touch, olfactory stimulation, vestibular stimulation, and auditorystimulation. At least one parameter of the stimulus may be varied whilesubjecting the patient to the stimulus. For example, the amplitude,frequency, and/or duration of the stimulus may be varied.

In accordance with further embodiments of the invention, subjecting thesubject to sensory stimulation may include sequentially subjecting thesubject to a plurality of stimuli selected from the stimulus group, themethod further including evaluating the physiological responses to thestimuli at the identified posture to identify a stimulus that providesan optimal physiological response by the subject. The physiologicalresponses to the identified stimulus at the identified posture may beevaluated to identify a parameter value that provides an optimalphysiological response by the subject.

In accordance with further related embodiments of the invention, thesubject may be treated, for example, by subjecting the subject to theidentified stimulus while the subject is in the identified posture. Thesubject may be repeatedly subjected to the identified stimulus, whilethe subject is in the identified posture, until a desired endpointphysiological condition is achieved. The desired endpoint physiologicalcondition may be a condition wherein subjecting the subject to astimulus from the stimulus group, other than the identified stimulus,does not cause dysfunction in the subject while the subject is in theidentified posture.

In accordance with still further related embodiments of the invention,upon achieving the desired endpoint physiological condition, the methodmay include, for at least one posture different from the identifiedposture, determining whether a dysfunction in the subject exists uponsubjecting the subject to a stimulus selected from the stimulus group.Upon existence of a dysfunction, the subject may be repeatedly subjectedto a stimulus selected from the stimulus group at the different postureuntil a further desired endpoint physiological condition is achieved. Ifno dysfunction in the subject exists while the subject is in the atleast one posture different from the identified posture, the method mayfurther include performing additional therapeutic modalities tofacilitate further enhancement of physiological condition.

In accordance with another embodiment of the invention, there isprovided a method for providing therapy using afferent nerve pathwaysfor a subject having a brain disorder, the subject having a body. Themethod includes providing a stimulus to the subject, over selectedportions of the body of the subject. The stimulus may include TENS,non-painful heat, non-painful cold, visual, occulomotor stimulation,vestibular stimulation or crude touch. Response of the subject to thestimulus is monitored with respect to at least one autonomicphysiological response of the subject. The autonomic physiologicalresponse may include oxygen saturation, heart rate, pupillary response,blood pressure, sweat production, pseudomotor activity or respiration.At least one stimulus parameter is adjusted, such as selection,intensity, location, and duration of the stimulus, so as to cause achange in the monitored response in a direction toward normal, whilelimiting stimulus parameters so that the stimulus is tolerated by thesubject.

In accordance with related embodiments of the invention, the method mayinclude simultaneously or consecutively providing to the subject anadditional therapeutic regime. The method may further include repeating,at different distinct postures, providing a stimulus, monitoringresponse, and adjusting at least one stimulus parameter. The distinctpostures may include walking, standing, sitting, and supine.

BRIEF DESCRIPTION OF THE DRAWINGS

The foregoing features of embodiments will be more readily understood byreference to the following detailed description, taken with reference tothe accompanying drawings, in which:

FIG. 1 is a flowchart showing a method in accordance with an embodimentof the invention;

FIG. 2 is a flowchart showing a method in accordance with a furtherembodiment of the invention;

FIG. 3 is a flowchart showing a method in accordance with anotherfurther embodiment of the invention;

FIG. 4 is a flowchart showing a method in accordance with anotherembodiment of the invention;

FIG. 5 is an exemplary patient log for use by a physician duringtreatment of an illness according to an embodiment of the invention; and

FIG. 6 is another exemplary patient log for use by a physician duringtreatment of the illness.

DETAILED DESCRIPTION OF SPECIFIC EMBODIMENTS

Various embodiments of the invention described herein produce lastingchange by incorporating different combinations of posture andenvironmental stimuli into the therapeutic regimen. Postures, such aswalking, sitting, standing, and supine, have different effects on theautonomic nervous system, and therefore some stimuli have differentphysiological efficacies while a patient or subject is in each bodyposition. Disclosed embodiments of the present invention leverage thisrelationship to determine a combination of posture and stimulus that hasoptimal therapeutic effect. These embodiments provide a treatment thatstimulates the nervous system through a combination of noninvasivetherapies that stimulate brain cells to increase their efficiency—thispromotes the formation of pathways that help transfer informationthroughout the brain in such a way that in the end, the affected area ofthe brain and overall brain function are improved without medication orsurgery. Indeed, the autonomic response advantageously may be addressedas the first step in the examination and rehabilitation process.Moreover, while a treatment may alleviate some symptoms of an underlyingdisability or illness, it might not cure all the causes of the illness.Thus, further embodiments provide for reevaluating the optimality of theposture/stimulus combination once relative normalcy has been achievedwith respect to a given monitored physiological response, to determinewhether any residual dysregulation remains.

The methods disclosed herein address one of the main problems inherentin injured or dysfunctional neurological tissue—that of fragility of thesupporting structures, and insufficient ability to supply adequate fuelneeded for the increased metabolic activity for repair of the damagedareas. This differs from prior approaches of non-emergent brain injurytreatment which generally employed a strategy of doing nothing or ofprescribing “rest”. The disclosed methods, by employing the followingsteps, have succeeded in the goal of providing for a greatersurvivability and favorable outcome of the neurological rehabilitationand recovery process.

As used in this description and the accompanying claims, the followingterms shall have the meanings indicated, unless the context otherwiserequires:

The “labyrinthine system” is the sensory system of the inner ear thatcontributes to movement and balance. It has two components: thesemicircular canal system, which indicates rotational accelerations, andthe otoliths, which indicate linear accelerations. The labyrinthinesystem signals to both the neural structures that control eye movementsand to the muscles that control posture. The labyrinthine system is partof the vestibular system, whose primary purpose is to detect the motionof the head and then generate reflexes that stabilize gaze and maintainthe body's posture in gravity.

The “vestibulo-ocular reflex” or “VOR” is a reflex eye movement thatstabilizes images on the retina during head movement by producing an eyemovement in a direction opposite to the head movement. Since slight headmovement is present at all times, the vestibulo-ocular reflex isessential for stabilizing vision.

“Smooth pursuit” refers to eye movements made while closely following ortracking a moving target. By contrast, “saccades” are rapid,simultaneous movements of both eyes in the same direction that redirectthe line of sight.

“Computerized tracking tests”, as defined herein, are clinical teststhat measure a patient's ability to match eye movements to visual targetmovements. Such clinical tests can be utilized to identify and diagnosedisturbances in the central nervous system.

“Video electronystagmography”, or “VENG” is a comprehensive evaluationof the oculomotor and vestibular systems comprised of computerizedtracking tests (smooth pursuits and saccades) and optokinetic nystagmus(“OKN”). The VENG evaluation can be used to detect involuntary movementsof the eye caused by nystagmus. As part of the VENG evaluation, patientsare typically fitted with light-weight goggles that house infraredcameras. The cameras track and record eye movements and pupillaryresponses to visual targets. When the test begins, patients are asked tomatch their eye movements to those visual targets (i.e. lines, dots,etc.) that are projected onto an LCD screen in front of them (which maybe provided using headgear approximately 2″ away from the patient, orusing a wall-mounted screen up to approximately 72″ away from thepatient). Tests typically range from 30-60 seconds, with varied targetvelocity, acceleration, and frequency. Throughout each test,computerized software measures the patient's overall accuracy andresponse time. For example, in some cases, the eye falls behind thetarget and has to make abrupt rapid movements to catch up (known as the“catch-up saccade”). At other times, the patient may be going fasterthan the target in anticipation of the next movement. Either responsemay reflect a disturbance in the central nervous system.

“Computerized dynamic posturography” or “CDP” is a non-invasive test ofbalance used to assess the central nervous system mechanisms involved inthe control of posture and balance. Generally, CDP is carried out byplacing a patient in standing posture on a fixed instrumented platform(force plate) with or without perturbing cushion. The platform isconnected to sensitive detectors (force and movement transducers) thatdetect subtle oscillations of the body. Tests typically span 20 secondswith varied movements and head positions (i.e. neutral, left rotation,right rotation, flexion, extension, downward gaze). CDP produces graphicmetrics that identify minute spontaneous body sways and overall balancescores. Abnormalities or below-average scores may reflect impairments inthe central nervous system (“CNS”) that affect the posture controlsystem.

A “caloric test” is a thermal test of the lateral semicircular canalsthat is used to identify disorders of the inner ear and/or to detectbilateral weakness of the brain. The standard bithermal caloric test maybe performed on patients by irrigating warm and cold water into each earsequentially. During the procedure, the patient is seated, with headinclined 30 degrees up from horizontal to ensure that the lateral canalis horizontal. Warm water is then slowly inserted into the ear canal onone side, using a large plastic syringe. The water is stopped after 30seconds, and spontaneous nystagmus is observed. After a rest ofapproximately 5 minutes, the test is repeated on the other side. If noresponse is detected, the test is repeated using cold water.

Temperature change can be manipulated to stabilize a patient's autonomicfunctioning. In a typical “temperature test”, the patient lieshorizontally on a bench. To dampen all forms of stimulation, the lightsare darkened, and the patient is offered ear plugs and red tintedglasses. Warm towels are then applied to the upper and lower extremities(specific side to be determined by the attending physician). Afterapproximately 5-7 minutes, the towels are replaced with new, warm water.This process trains the autonomic system to withstand environmental andphysiological changes, thereby stimulating small diameter afferents toelicit autonomic responses.

“Chair rotation with visual fixation” is a test used to identify thepresence of a central (cerebellar or brainstem) lesion. For thisdiagnostic test, the patient is seated upright in a rotating chair andasked to fix his/her eyes on a clearly visible target. Typically, thepatient holds a pen in his/her hand and focuses his/her gaze on the tipof that pen. The patient is then spun slowly in either direction (to bedetermined by the attending physician based upon the cerebellar deficit)in quarter turns. Throughout this exercise, the physician observes theadequacy of gaze holding. Impaired gaze holding, or a drift of the eyein a certain direction, may indicate the presence of a lesion.Additionally, this exercise is utilized as a therapeutic modality totrain the cerebellum and frontal lobe to suppress the nystagmus reflexthat occurs during rotation.

“Transcutaneous electrical nerve stimulation” or “TENS” is anon-invasive, low-risk form of nerve excitation used to reduce acute andchronic pain and/or myospasm. A portable TENS unit is typically applieddirectly to the skin using two or more electrodes. The standardbattery-operated TENS unit modulates pulse width, frequency, and/orintensity.

“Gait” means a manner of walking.

“Brain timing and sequencing” refers to a computerized evaluation thatidentifies the motoric system's processing speed in executing complexmotor commands in response to a generated auditory cue. Temporaldifferences between the auditory cue and the patient's performance aremeasured in milliseconds, reflecting the patient's overall processingspeed. To strengthen brain timing and sequencing, the complex motorcommands—including hand and foot exercises—are repeated as therapeuticactivities once treatment progresses.

“Stimulation” or “sensory stimulation” means any form of sensorymodality that is used for diagnosis or treatment of a disease, andincludes visual stimulation, auditory stimulation, occulomotorstimulation, olfactory stimulation, vestibular stimulation, vibratorystimulation, caloric stimulation, temperature-change stimulation, TENS,non-painful heat, non-painful cold, and crude touch.

“Subject” or “patient” means an individual being treated for an illness.

“Illness” means an illness of a human being, and includes, among otherthings, migraine, reflex sympathetic dystrophy (RSD) syndrome or complexregional pain syndrome (CRPS), postural orthostatic tachycardia syndrome(POTS), concussion, traumatic brain injury (TBI), apraxia, apraxia ofspeech, aphasia, cervicogenic dizziness, migraine-associated vertigo,vestibular illnesses, attention deficit hyperactivity disorder (ADHD),autism, Asperger Syndrome, fibromyalgia, chronic fatigue, mal dedébarquement syndrome (MdDS), multiple sclerosis (MS), Parkinson'sdisease, restless leg syndrome (RLS), insomnia, dysautonomias,peripheral nerve injuries, tremors, ataxia, asthma, and sciatica.

A summary of investigations into eye movements, their role inunderstanding brain function, and their use in diagnosis of neurologicalconditions can be found in a primer on visual neuroscience, entitled“Neuroscience of Eye Movements” by R. John Leigh, MD, FRCP and SangeetaKhanna, MD, published by ACNR, VOLUME 5 NUMBER 6 JANUARY/FEBRUARY 2006.This paper as well as the book it references, Leigh R J, Zee D S, TheNeurology of Eye Movements (Book/DVD), Fourth Edition, 4 ed. New York:Oxford University Press, 2006, are hereby incorporated herein byreference. In summary, this paper states that an understanding of normaleye movements, and knowledge of their biological substrate, purpose andproperties will greatly assist in determining the location of aneurological lesion. Dr. Leigh asserts that most diseases that affectthe brain have, to some degree, an effect on eye movements.

FIG. 1 is a flowchart showing a method for evaluating dynamic autonomicdysregulation in a subject in accordance with an embodiment of theinvention. In a first process 101, a patient or subject is directed tosequentially assume a plurality of distinct postures. These postures mayinclude, for example: standing, sitting, supine, and/or walking.

In a second process 103, in each of the assumed body positions, thepatient or subject is subjected to sensory stimulation while at leastone autonomic physiological response is simultaneously measured. In anexemplary embodiment, the patient is examined using a pulse oximeter ineach of these positions to measure blood oxygen saturation; however,other physiological responses such as heart rate, pupillary response,blood pressure, sweat production, pseudomotor activity, and respirationalso may be measured in accordance with various embodiments.

An exemplary process 103 is now described in more detail. First, aphysician may direct the patient to stand, and place the pulse oximeteron one of their fingers. Next, the physician takes an initial readingwith the patient standing with their head facing forward and their eyesopen. Next, the physician moves the patient's head into each canalposition (left horizontal rotation, right horizontal rotation, leftposterior extension, right anterior flexion, right posterior extension,and left anterior flexion) with the patient's eyes remaining open. Afterplacing the patient's head in the each of the canal positions, thephysician takes and records pulse oximeter readings while having thepatient place their visual axis in a neutral position, then inipsilateral gaze, then in contralateral gaze. The head positioningprocedure and readings are repeated with the patient's eyes closed. Thisoverall procedure is repeated with the patient sitting, then lyingsupine. Finally, a recording is taken with the patient walking briskly.

While the stimulation described above involves repositioning of the earcanals through head movement and adjusting the patient's gaze, othersensory stimulation may include, for example, visual stimulation (e.g.,quadrantinopial and hemianopial stimulation) and auditory stimulation(e.g., a pitch changing from a low frequency to a high frequency). Ifthe subject is sitting in a chair, sensory stimulation may include chairrotation with head fixed and with or without visual fixation. Othersensory stimulation could include efferent copy stimulation, such asrequiring the subject to perform motor tasks. Still other sensorystimulation includes vibratory stimulation, gyroscopic stimulation,temperature change stimulation, and TENS. The stimulations of process103 may be chosen to differentiate between the various components of thevestibular system, including the visual component, the labyrinthinecomponent, the spinal component, and the cortical component. The process103 aids in determining the competent stimulation that will be used fortreatment.

In a third process 105, the physiological responses for each posture areevaluated to identify a posture wherein the patient or subject exhibitsa least amount of dysfunction. The physiological responses for eachposture may be assigned a score based on the amount of dysregulationindicated, for example, and these scores may be combined to form a scorefor each posture that represents the overall amount of dysfunction. Atthis time, a body posture of greatest dysfunction may be determined touse as a baseline against which to measure the efficacy of the treatmentregimen. If the posture is recumbent, then the patient's sensorystimulation tolerance needs to be determined by performing a furtherbattery of tests using the above-described stimuli. These sensorystimuli are provided with respect to both the left cortex of the brainand the right cortex of the brain to identify whether the measuredphysiological response indicates an increased or decreased dysregulation(i.e., a further or closer distance from a normal value), and act as aconfirmation of the competent stimulation.

At some time during the examination, the physician may employcomputerized dynamic posturography to confirm various properties of theinjury or illness, such as a lesion's side and level diagnosis forexample. Thus, for example, the physician may direct the patient tostand with their eyes closed and record a stability score andfatigability ratio for each of the following positions: head facingforward, head turned leftward, head turned rightward, headdown-rightward, head back-leftward, head down-leftward, and headback-rightward. The physician may then repeat the procedure forautonomic stressors. Also, the physician may perform a VENG examinationto set a baseline for the autonomic subsystems, and perform apupillometry examination to confirm changes to the baseline.

It should be understood by one skilled in the art, that many othercombinations of stimuli, different monitoring windows, and examinationorder or operation may be employed.

FIG. 2 is a flowchart showing a method in accordance with a furtherembodiment of the invention. Process 201 simply requires performing theprocesses of FIG. 1 to identify an optimal posture. Process 203 requiresevaluating physiological responses to the stimuli at the identifiedposture to identify a particular stimulus that provides optimalphysiological response by the subject while in that posture. Thus, whileprocess 105 identifies an optimal posture for treatment as a function ofa variety of stimuli, process 203 identifies the best stimulus for theoptimal posture.

Process 205 fine-tunes the treatment regiment by evaluating thephysiological responses to the identified stimulus at the identifiedposture, to identify one or more parameter values that provide anoptimal physiological response by the subject. Thus, if the processes101 to 203 identify auditory stimulation in a supine position as themost efficacious treatment, process 205 would determine, for example, aduration, amplitude, and frequency of the auditory stimulation thatproduces the least dysfunction. Other combinations of posture andstimulus require optimization of other parameters, as should be apparentto a person having ordinary skill in the art.

Once these processes 101-205 are complete, a treatment strategy may bedetermined. Such a strategy is a function of at least four elements. Thefirst element is the posture of least dysregulation, which is used todetermine a best posture for treatment. The second element is a rankingof stimulation modalities in terms of their effectiveness ofphysiological response, with the optimal modality being preferred. Thethird element is the quality of the motor response to the competentstimulus, which is used to determine the duration, amplitude, andfrequency of the optimal stimulation. The fourth element is thecollection of sensory modalities or stimulations which drive the vitalcenters toward normalized physiology or normal autonomic windows, asthese adaptive competent stimulations are capable of producing adaptiveneuroplasticity, and therefore promote system integrity and function.Other elements may be considered in determining the treatment strategy,if deemed relevant by the physician.

In some situations, when a desired endpoint physiological condition isreached, subjecting the patient to a stimulus other than the identifiedoptimal stimulus does not cause dysfunction while the subject is in theidentified posture. In such situations, the patient may be approaching astate of physiological normalcy. However, even if a patient is treatedaccording to an optimal posture and an optimal stimulus until thatpatient shows relative normalcy, it may be that the particular treatmentregiment has addressed only one observed symptom of the underlyingillness, and other stimuli may cause reactions indicative of continueddysfunction. FIG. 3 is a flowchart showing a method in accordance withanother further embodiment of the invention that detects this situationand rectifies it.

Process 301 simply requires performing the processes 101-203 to identifyan optimal posture and an optimal stimulus. The next process 303 callsfor repeatedly applying the identified stimulus to the subject at theidentified posture until a desired endpoint physiological response isachieved. However, once a normal response is observed for this firstposture, process 305 determines, for a posture different from the firstposture, whether a dysfunction exists upon applying a stimulus. Itshould be noted that the stimulus applied need not be the identifiedoptimal stimulus, but may be any appropriate stimulus as describedabove, and that the dysfunction need not be the dysfunction identifiedduring the diagnostic processes 101-105. If the process 305 determinesthat there is no dysfunction, then the treatment is consideredsuccessful and may end as indicated in FIG. 3. However, if the process305 determines that a dysfunction is still present, then in process 307,the physician repeatedly applies a stimulus at the different postureuntil a desired endpoint physiological response is achieved. Thus, thephysician may repeat the processes 201-205 to determine the optimalstimuli for the new posture, and apply process 303. If required, thetreatment regimen may require several such applications and visiting aposture several times until normalcy is attained. The physician maytrack the patient's physiological reactions in the various posturesusing a patient log, for example a log of vital signs as reproduced inFIG. 5, and may correlate this information against the effects ofvarious stimuli on the patient's posture control, as recorded in a CDPlog such as the one reproduced in FIG. 6.

The above embodiments of the invention are directed to the advantages ofthe use of different postures in treating illnesses. Some of thesestimuli cause physiological reactions that operate on efferentnerves—the nerve fibers that carry signals away from the CNS toward themotor system to cause movement. For example, intentional eye movementsmay be an effective diagnostic tool if the efferent nerves that carryelectrochemical signals from the brain to the ocular muscles arefunctioning properly. However, such intentional movements may not occurif the CNS does not receive the stimuli in the first place. Suchnon-reception may be due to damage of the afferent nerve fibers—thenerve fibers that carry stimuli from receptors or sense organs towardthe CNS.

In subjects with localized damage or loss of the afferent nerves, somestimuli such as pain, heat, itchiness, pressure, and sense of touch thatoriginate in those damaged areas will not reach the CNS. This may occur,for example, in subjects who have lost limbs or suffered severe burns.For these subjects, the processes described above may be ineffective oncertain areas of the body, but effective in other areas that havefunctioning afferent nerves.

FIG. 4 is a flowchart showing a method in accordance with anotherembodiment of the invention. This method provides therapy usingdifferent afferent nerve pathways for a subject having a brain disorder.In a first process 401, a physician provides a stimulus to the subjectover selected portions of the subject's body. As described above, thesestimuli may include TENS, non-painful heat, non-painful cold, visualstimuli, auditory stimuli, occulomotor stimuli, vestibular stimuli,crude touch, or any other stimuli herein disclosed. In a next process403, the physician monitors the response of the subject to the stimuliwith respect to at least one autonomic physiological response. Thisprocess is similar to process 103, except that the diagnostic variableis body location rather than body posture or orientation. In particular,the measured autonomic physiological response may be blood oxygensaturation, heart rate, pupillary response, blood pressure, sweatproduction, pseudomotor activity, or respiration. In a further process405, the physician adjusts at least one stimulus parameter to cause achange in the monitored response in a direction toward normal, whilelimiting stimulus parameters so that the stimulus is tolerated by thesubject. The adjusted parameter(s) may be, for example, selection,intensity, location, or duration of the stimulus.

In accordance with the embodiment of FIG. 4, the physician maysimultaneously or consecutively provide an additional therapeutic regimeto the subject to promote better healing. Moreover, the teachings of theembodiments of FIGS. 1-3 may be combined with the embodiment of FIG. 4,so that once a suitable body location is found for application ofstimuli, these stimuli may be applied to that body location as autonomicphysiological responses measured and recorded, while the patient assumesa variety of postures (e.g., walking, standing, sitting, and supine).

Successful Treatment Example: Post-Concussion Syndrome

A 25 year old female presented for Cortical Integrative Therapy (“CIT”)evaluation and treatment of symptoms related to a mild traumatic braininjury, post-concussion syndrome (PCS), subsequent to a sports relatedhead injury that resulted in concussions 8 years prior. The concussionoccurred while she was participating in a high school basketball game.

After seeing approximately 80 physicians and therapists the patientcontinued to experience many residual symptoms from her head injury;headaches, dizziness, neck pain, stiff neck nervousness, fatigue,irritability, cold sweats, and her eyes having an excessive sensitivityto light. Her daily headaches continued (pain rated at 4-5 out of 10),and she continued with difficulty with focus and concentration. Thepatient reported never having these issues prior to the head traumas andnow her current symptoms were interfering with her routine activities ofdaily living, including; her job, schooling, and sleep. She reportedthat reading, bright lights, and tasks that requireconcentration/focusing were what tend to aggravate her symptoms themost. The patient described light headedness daily, usually for bouts ofabout 10 minutes at a time. These episodes were accompanied by hervision getting blurry and the sensation she was going to fall over,although she never fell. She also described “her eyes blacking out”,which occurred occasionally when she stood up rapidly. Doing so wouldcause her to lose her vision until she bent down, but this would causenose bleeds, limiting her strategy to abate the visual disturbance.Additionally, the patient reported “jaw issues” subsequent to her headtrauma as she sustained torn cartilage in her TMJ. This appeared to be acontributing factor in her headaches.

The patient reported that her initial symptoms (severe migraines,nausea, trouble with focus and concentration, and major balanceproblems) were addressed by at least three different hospitals. Most ofthe care consisted of pain medications and antidepressants. She receivedintensive physical therapy to help her to learn how to walk withoutfalling over. The patient reported she followed this care plan for fouryears without much benefit.

The patient subsequently was referred to another hospital, where shereported being admitted for approximately 8 days on two separateoccasions. These hospital stays consisted of high powered pharmaceuticalinterventions, including fentanyl patches, other narcotics, and Botoxinjections, attempting to treat her migraines. Unfortunately, thesetreatments had little to no benefit. Acupuncture and traditional Chinesemedicine appeared to greatly decrease the number of migraines shesuffered to just “severe” headaches. This change permitted the patientto attempt taking some college classes. In the semester prior to seekingcare at this office, she took three online courses. She would be able toread for 20 minutes at a time, but would then have to go lie down andclose her eyes. The patient reported increased headaches, difficultyremembering what she was learning and was easily distracted. Shereported that doing homework was akin to “the feeling of having finishedrunning a marathon and then getting a headache”. The patient reportedfeeling that she was going backwards, and it was scaring her intoseeking further evaluation and treatment.

CIT treatment began Jan. 7, 2013. During the evaluation process, a TENSunit was placed on different areas of her body. When it was placed onher left lower extremity it produced good stabilization of her heartrate, monitored by pulse oximeter: lying down the PO2 reading was 97with heart rate 51 beats per minute, sitting the reading was 97 withheart rate 58 BPM, standing the reading was 99 with heart rate 73 BPMbut with swings in heart rate in excess of 25 BPM at rest, bilaterally.The dysregulation was least while lying down, so her selected positionfor treatment was determined to be recumbent.

The patient was seen twice daily for 60 minutes where she was treated ina darkened environment and received application of warm moist towels,and a TENS unit on the right side. Over six treatment days, the swingsin dysregulation narrowed over time to 1-5 BPM during head maneuvering.

After this, the patient graduated to the seated position where theprocess was repeated for three days, at which point she was able tosustain head movements, pursuits and optokinetic nystagmus (OKN) with3-5 BPM variations. The patient then graduated to having the same regimeapplied while standing. On her tenth visit, we commenced addingadditional modalities while her injury was treated as a lefthemisphericity/right cerebellar diaschisis. The following additionalmodalities were performed daily over the course of the following sixweeks were:

1. Left pursuits which are performed at 0.3 Hz, for 30 seconds.

2. Right lower quadrantinopial stimulation at a frequency of 0.3 Hzred/green checkered pattern for 30 seconds.

3. Right upper quadrantinopial stimulation at a frequency of 0.3 Hzred/green checkered pattern for 30 seconds.

4. Right Hemianopial stimulation at a frequency of 0.3 Hz red/greencheckered pattern for 30 seconds.

5. Left OKAN performed at 0.3 Hz, for 30 seconds.

6. Right chair spin with visual fixation.

7. Right warm caloric treatment.

8. Spinal manipulation in coupled reduction to restore properbiomechanics and increase afferentation to the right cerebellum and leftcortex.

9. Application of TENS unit for increased parietalization.

The visual and oculomotor activities were conducted in sets of 3repetitions with 1 minute rest intervals. Treatment was performed withinheart rate dynamic range below 95 BPM, with repetition and rest countsmodified based on metabolic capacity. Treatment session time was 75minutes.

By January 17th, we incorporated brain sequencing and timing activity inorder to add movement parameters which were previously overwhelming.Continued repetition produced stabilization of autonomic regulation,permitting decrease in all symptoms and the improvement in her cognitiveand overall functionality. The patient was discharged from active careon Mar. 4, 2013, at which time she returned to gainful employment andenrolled in Fall semester college classes.

Sample Therapeutic Regimen #1: RSD

Background: M. G., a 28-year-old female presents with reflex sympatheticdystrophy (RSD) in her right hand and wrist. Subsequent to sustaining awork-related injury, her right hand and wrist became excruciatinglypainful. The pain resulted in a limited range of motion in her rightshoulder, elbow and wrist due to the patient's attempt to protect herextremity from movement and from being touched by anything. Blood flowimaging demonstrated significantly decreased blood flow to the rightforearm and particularly to the right wrist and hand. She alsodemonstrated limited movement of the cervical spine in rotation as wellas extension. She initially forbade examination of her affectedextremity due to excruciating pain.

Diagnosis: RSD (right hand and wrist) and decreased range of motioncervical spine in rotation and extension.

Typical office visit: The patient is greeted and escorted into thetreatment room. Due to the patient's metabolic fragility, she is helpedto lie down on the treatment table and the lights of the room aredimmed. Her pain on this day was listed at a 6 on a numerical painrating scale 0 to 10 scale (0 being no pain, 10 being the most pain). Apulse oximeter is placed on her finger and used to measure the O2saturation and heart rate. The initial readings are recorded, and thenumbers are used to track and modify the therapeutic interventionchoice, intensity and duration, so as to not exceed the patient'smetabolic capacity during the activity. Her initial heart rate and O2saturation are 92 beats per minute and 97% respectively. A warm moistcloth is placed on the patient's lower right leg, which is based uponfavorable outcomes from last visit. The patient's heart rate lowers to78 BPM and her O2 saturation is unchanged when the warm moist cloth ismoved up to her superior medial knee area. The warm moist cloth is heldat that location for two minutes, then the cloth is replaced with afresh one to maintain the temperature level. The warm moist cloth isheld at the location for a total of six minutes at two minute intervals.The heart rate stabilized to a range of 75 to 78 BPM. Her pain loweredto a 2 on the numerical pain rating scale.

The patient is then assisted to a seated position. After an initialfluctuation of her heart rate and PO2, it stabilizes back to the 75 to78 BPM range. This is different than the previous visit in which shedestabilized dramatically upon rising to a seated position from a supineposition. Next, the patient remains seated and positioned so as to beable to view a projection screen, at a distance of about 72 inches. Thepatient is allowed to rest for one to three minutes while the nextactivity is set up.

Red tinted lens glasses are placed upon the patient, to lower thestimulation level. The warm moist cloth and pulse oximeter remain asprior, and Right Lower Quadrantinopial stimulation, displaying ared/green checkerboard pattern alternating at a 0.3 Hz for a duration of30 seconds, is performed for six repetitions. The patient is instructedto fixate on the large red dot at the center of the screen while thecheckerboards are flashing. The heart rate and PO2 are monitored andmaintained at the 75 to 78 BPM range during the visual stimulation. Thepatient reports that her pain drops to 0 on the numerical pain ratingscale. The patient is allowed to rest for one to three minutes in thedarkened room. The treatment session's duration, including rest timesneeded, is 45 minutes.

The patient was scheduled to return the next day to continue with herprescribed treatment plan of a 2-week course of daily treatments,followed by a thorough reevaluation. The patient's cervical spinecomplaints was addressed when she became consistently, for 2 visits,without pain at the start of office visit.

Sample Therapeutic Regimen #2: RSD

Background: C. S., a 31-year-old female presents with RSD in both handsand arms. Her condition appeared as a result of chronic trauma andmanifests as severe pain, weakness, and numbness of gradual onset, firstin the right hand and arm then to include her left hand. Her left handeventually became the area that was most symptomatic. A physiciandiagnosed carpal tunnel syndrome with flexor tendonitis. A surgeonoperated on the patient's left wrist and trigger finger. Upon onset ofoccupational therapy, the patient began to experience increased pain,rating her pain at an 8 on a numerical pain rating scale 0 to 10 scale(0=no pain, 10=most pain), with hypersensitivity in the area of thescar, and decreased grip strength on either hand. Migraines and insomniaare concomitant to her main complaints. C. S. has a history ofdepression, anxiety, and memory difficulties.

Diagnosis: RSD (bilateral forearms and hands) and history of left wristcarpal tunnel surgery.

Typical Office Visit: The patient is greeted and escorted into thetreatment room. On this day C. S. presented with her left hand painsignificantly worse than her right hand. She rated her right hand painat an 8 and her left at slightly less. She had additional symptoms ofdaily severe headaches, which she attributes to her lack of sleep. Sherated her headaches at 9 on this day. She reported that her hands andfeet sometimes felt abnormally cold to the touch. Despite her obviouspain, C. S. presented with a pleasant demeanor. A pulse oximeter isplaced on her finger and used to measure the O2 saturation and heartrate. The initial readings are recorded, and the numbers are used totrack and modify the therapeutic intervention choice, intensity andduration, so as to not exceed the patient's metabolic capacity duringthe activity.

A TENS unit is then fitted on the patient's left upper extremity,shoulder, and TMJ area, and she is seated in a chair about 72 inchesfrom a projector screen. The room lights are lowered to facilitatebetter viewing. A left inferior quadrantanopial visual stimulation,consisting of red/green small checker squares is displayed with analternating pattern at 0.3 Hz for a duration of 60 seconds, is performedfor 6 repetitions. The patient is allowed to rest for one to threeminutes in the darkened room.

Next, the patient is fitted with infrared camera goggles, generally usedfor VENG evaluations, which is used to monitor and record her eyesduring the therapeutic pursuit eye movements, observing for breakdown ofsmooth movements. Six sets of rightward pursuits are performed at 0.3 Hzfor 60 seconds, with a 60-second rest period between each set. Next, thepatient is then escorted to a manual therapy room and is allowed to restfor one to three minutes.

Manipulation of the patient's thoracic spine and rib cage is performedto improve rib cage expansion, and therefore tidal volume. Her leftshoulder is also manipulated to help normalize the overall muscle tonearound her shoulder girdle. The patient is allowed to rest for one tothree minutes in the darkened room.

C. S. tolerated the session well and reports a decrease in left handpain to a 4, and her headaches were significantly improved. Thetreatment session's duration, including rest times needed, is 60minutes. The patient is scheduled to return the next day to continuewith her prescribed treatment plan of a 2-week course of 2 days-on-1day-off office visits, followed by a thorough reevaluation.

Sample Therapeutic Regimen #3: RSD

Background: A. S., a 13-year-old male presents with a generalized RSDthat causes severe to excruciating pain from the crown of his head tohis buttocks and groin, with focal concentration targeting in theabdomen. He reports a rather lengthy medical history consisting ofunrelenting pain, severe headaches, vertigo, dizziness, flushed face,neck stiffness, cold sweats, upset stomach resulting in frequent nauseaand vomiting, extreme sensitivity to light, and generalized paraesthesiathat is distributed over his entire neck and trunk.

Diagnosis: RSD (global).

Typical Office Visit: A. S. is greeted and using a wheelchair to maketransport easier is helped into a treatment room. On this day, thepatient's pain is rated at a 9+ on a numerical pain rating scale 0 to 10scale (0=no pain, 10=most pain), and is very sensitive to any stimuli,including noise, light, and incidental touching of his body.

The patient remains in the wheelchair and the lights are dimmed toincrease his comfort level. A pulse oximeter is placed on his middlefinger. His initial heart rate is recorded at 102 beats per minute,fluctuating at ˜+/−10 beats (92 to 112 BPM). Red tinted glasses areprovided to the patient to even further decrease the level of lightstimulation he is receiving. He appears to tolerate wearing the glasseswell. The patient rests with the glasses on for 3 minutes. During thistime his heart rate decreases fluctuating and stabilizes at about 102beats per minute.

Warm water is prepared at about 104 degrees F., while the patientremains seated. A collection basin is positioned under his left ear.Using a needleless syringe, 25 ml of warm water is gently squirted intohis left ear canal; the water is collected as it flows back out into thebasin. This is repeated four times. A. S. tolerates the warm water well.During the caloric stimulation the patient's heart rate lowers to 76beats per minute with only slight fluctuations. A. S. states that hefeels some relief at this point, and is allowed to rest for about threeminutes as the next activity is set up.

Next, A. S. is fitted with over-the-ear headphones. The room remainsdarkened, and the patient continues to wear the red tinted glasses andpulse oximeter as prior. Auditory stimulation is provided to his leftear starting with low frequency tones at a low volume and graduallyincreasing the volume as well as the frequency until a decrease andstabilization in the heart rate is observed. The patient's heart ratehad crept back up to 81 beats per minute as he was being fitted with theheadphones. Application of the correct tone brought his heart rate downto and stabilized it at 74 beats per minute. The tone is applied for 30seconds with a rest of 30 seconds, six times. A. S. tolerates thistherapy quite well, and reports his pain to be a 0 on the numerical painrating scale.

The treatment session's duration, including necessity of taking extracare during the fitting of the therapeutic equipment on the patient dueto his lack of tolerance to most stimuli, as well as the patient'sneeded rest times, is 60 minutes. He left the office asymptomatic andwithout any assistance needed. A. S. is scheduled to be seen for afollow-up in two days.

Experimental Case Study #1: Hand Replantation

Between 2002 and 2007, hand replantation was performed in three malesranging from 8 to 22 years. While all three males received conventionalhand therapy, the third case also received experimental treatment inaccordance with some of the techniques described above. At theconclusion of this study, each patient achieved a useful but diminishedfunction of their replanted hand. However, the patient who received theexperimental treatment demonstrated better overall functioning,suggesting that cortical configurations in the brain-central nervoussystem and hand can be externally influenced and even partially restoredin the case of hand replantations.

Summary: The aim of this case study was to report on the functionaloutcomes of non-dominate hand replantation. For the case receiving theexperimental treatment, the purpose was to see how the neurocortical,sensory, and motor stimulation described herein affects peripheral nerveregeneration and function outcomes.

The convalescence period was over 12 months for all three cases. Eachcase noted the return of discriminative sensitivity of the digits.Active finger motion was reported as satisfactory in each case. The casereceiving the experimental therapy was the only one to demonstrateintrinsic muscle function. Pinch and grip strength was 40 to 60% lesscompared to the non-replanted hand. Following the eight weekexperimental regime, the patient demonstrated dramatic improvement infine motor control, haptic perception, precision grip control, andsensorimotor-influenced sensation in the fingertips of the replantedhand. The final outcome resulted in this patient having better overallfunction of the replanted hand.

Evaluation and Treatment: A 21-year-old right-handed Hispanic male had aleft hand replanted after being amputated at the forearm in anindustrial accident. Although the subject regained movement of alldigits following the successful replantation, at pre-treatment forinitiation of the experimental therapy, he was experiencing no sensationin the exposed digits of the replanted hand. Although he had re-acquiredthe ability to grasp, his fine motor coordination and control weresignificantly impaired. The purpose of this examination was to evaluatethe motor sequencing and timing aspects of the upper extremity and hand.Subsequent to a drastic trauma such as amputation, a period of disuseensues. During such a period changes in the motor centers of the centralnervous system occur almost immediately, and begin to lose coherenceover time, as well. In the experimental therapy, the optimization of thefine motor functionality can be evaluated and addressed not only fromthe aspects of dexterity, efficiency of movement and co-ordination, butalso as it pertains to sensory-motor processing, and autonomicfunctional integration. Thus the goal of therapy was to optimize theautonomic regulation of the fuel delivery (i.e. blood flow) torecovering systems and structures, as well as, the supportingstructures, and to minimize the degree of dyspraxia and improve hand-eyecoordination and the associated central nervous system consequences.

A severed hand completely disrupts the intricate brain-hand connection.Sometimes a “ghost” or “phantom” haptic perception remains. Almostimmediately changes in the motor and sensory areas of the braincommence. Over time the coherence within these regions is lost. Thefaster the hand can be replanted, the better, centrally as well asperipherally.

On the day of the amputation the patient was transferred to a largehospital associated with a university medical program where thereplantation was successfully performed. The patient immediatelyregained gross motor control of his hand with slow, uncertain movements,as well as rudimentary grasping function. He was able to move all digitsbut lacked dexterity.

As the patient's condition improved he was able to commence standardhand therapy. This consisted of movement, patterning, and repetitiveexercises. About six months following the patient's traumatic amputationand replantation, he began the experimental therapy. At pre-treatment,he had re-acquired the ability to grasp, and in fact, grasp stabilitycontrol with his left hand was nearly average, and he could move all ofhis fingers using gross motor movements. His fine motor control andprecision grip remained significantly impaired; however, the patient wasunable to grasp small objects with the distal tips of digits. Thisprecision grip impairment also indicated a significant degree ofsensorimotor impairment, a condition that affected the patient'sfunctional haptic perception. The patient also presented withsignificant dyspraxia especially as it related to sensory-motorprocessing and sensation. A sensory examination confirmed that nosensation existed in the exposed digits of the replanted hand. Thepatient was also examined as to joint position sense, two-pointdiscrimination, and vibration calibration. Firing of diffuse sensoryreceptors was attempted via the application of a TENS unit at itsmaximum setting, but without immediate results.

The patient initially presented as alert, pleasant, and cooperative forexamination. He had a bandage over the wounded wrist and hand with hisfingers mobile and exposed. Results obtained from a recent examinationby a hand therapist and a handwriting sample was provided, these servingas baseline metrics.

The patient's pulse ox reading was taken per digit. P/O2 measurement ofthe right hand revealed: thumb 99/73, index finger 98/68, middle finger97/67, ring finger 98/73, and small finger 99/71. The left handmeasurements were 98/73, 98/66, 99/63, 99/69-84 and 99/66-71; a headturn to the left produced 5-7 point variations, proving to be a windowof left cerebellar function. Physiological blind spot mapping wasperformed to identify any decrease in cortical processing as aconsequence of decreased sensory information from the affectedextremity. Cortical blind spot mapping revealed an enlargedphysiological blind spot bilaterally that maximized on the left. Thisleft blind spot measured at 525 square units; top half 258, bottom half267. A right blind spot was calculated at 653 square units showing316/337. The increased left blind spot seemed to reflect decreasedprobability of summation, probably a consequence of decreasedafferentation from the injured limb and hand. Additionally theorientation of the visual axis was predictably eschewed; there existed ahyperopia ipsilateral adjacent to the lesion. The find of an enlargedright blind spot was in all probability due to decreased fuel deliveryto the left cortex as a consequence of increased alterations insympathetic tone. This was consistent with the earlier P/O2 findingsipsilaterally with fluctuations of the left hand fuel delivery, again, alikely consequence of decreased ponto-medullary integration secondary todeafferentation from his cerebellum due to the affected upper extremity.

Treatment: A battery of tests was included as part of a second baselineused for initiating and monitoring the experimental therapy.Computerized dynamic posturography (CDP) was performed in order toevaluate integrity of the Parietoinsular vestibular cortex (PIVC) whichshares functionality of movements in both hands as well as truncalstability. The patient demonstrated decreased stability and actuallyfell off the platform in each head position except for left rotation.Aided by application of a TENS unit, the patient was able to complete a20-second posturography test in all previous head positions.

VENG testing revealed an excycloversional movement of the right eye andincycloversional movement of the left eye on vertical elevation in thedark. An autonomic response on elevation and a depression in referenceto pupillary constriction was observed. A computerized metronomesequencing device showed the average number of milliseconds required forthe patient to execute a movement. The specific hand and finger activitywas physically demonstrated and verbally explained. The patient wasasked to push a trigger placed in front of him at eye level. Repetitionswere meshed with auditory cues. Execution of motor activity was measuredin milliseconds and recorded for all ten fingers, in neutral, left, andright head rotation. A mark made on the floor of the treatment boothserved as a positional baseline for fine motor execution. Eye-handtarget testing was performed utilizing an eye patch. A notable breakdownin movement when utilizing the uninjured limb with the target presentedin the left hemi-field of vision was noted. The patient was markedlyless efficient when utilizing the affected limb in both left and righthemi-fields; however the patient was least efficient when using the leftupper extremity in the right field of vision. TENS unit applicationagain ensued to summate the parietal area adjacent to the somatotopichand representation. This allowed the dysdiadokinetic nature of hisapraxic limb movements to improve. Warm caloric irrigation was providedto the patient's left ear to increase middle cerebral arterial bloodflow to the contra-lateral cortex and as a physiological attempt toenhance left hand movement. TENS unit was applied to patient's upperextremity, neck, and face. Visuomotor/visuospatial strategies wereutilized. Retraining of eye-hand coordination and motor processingskills were executed via brain sequencing and timing technology.

The patient's pulse rate stabilized at 61-63 beats per minute with hishead in neutral and rotated positions. The measurement was taken on thering finger of the transplanted left hand. Peripheral autonomic functionimproved, boding well for the healing of tissue and also nerveregeneration. A post treatment handwriting sample was markedly morelegible than the earlier one submitted by the patient pre-treatment,indicating cortical improvement.

Following completion of the 8-week experimental regime, a significantdegree of sensation and coordination of fine motor control movementsincluding, fine motor control, haptic perception, precision gripcontrol, and sensorimotor-influenced sensation, were largely restored tothe subject's replanted left hand.

Experimental Case Study #2: Concussion

An eleven year old female presented for care accompanied by her parentsfor evaluation of post-concussion syndrome. She sustained a sportsrelated injury about one year earlier while playing basketball. First,she struck her left temporal area against another athlete's shoulder andfell backwards without breaking her fall or bracing herself. She struckthe back of her head directly, and then possibly her right shoulder on ahard wood floor. She has made progress with treatment to date, howevershe remains with residual headaches, and upper neck pain, severe lightand sound sensitivity that results in fatigue and increased headache.She describes an unpredictable nature to the onset of symptoms which areaggravated by stress, reading, writing, and traveling in a vehicle. Sheis sensitive to movement with resultant varying degrees of increasedsymptomatology after a period of physical activity. Her diagnosis hasincluded concussion syndrome, whiplash, and greater and lesser occipitalneuralgia. The patient claims that there is never a period of time whereshe was asymptomatic since her injury and on a scale of 0 to 10 fornumeric pain rating (NPR) describes a typical day as a rated a 2, withher worst days reaching an 8 out of 10. She rates herself a 5 at time ofconsultation due to the ride to the office.

Interestingly, in the patient's past history she has suffered from TMJdysfunction which predates the head injury, and has had a historydysautonomia since infancy. The dysautonomia presented in the form ofcold lower extremities particularly during cold weather, she will get“purple, cold feet”, poor intestinal motility and has suffered fromconstipation her entire life. She has been on Miralax and othersofteners since birth, she has had mild difficulty with food or drinkcoughing easily since the injury. Alternately she gets very “hot” butdoes not sweat when she gets stressed or anxious. She denies anyfasciculations, involuntary movements, tachycardia, and difficultystarting, stopping or holding her urine. No dry eyes or mouth. She hasdifficulty sleeping and is taking Neurontin and melatonin however stillstruggles with her sleep patterns which predictably cause greaterheadache and fatigue the following day. Additional triggers for theheadache and neck pain are identified as cognitive stress, entering amarket or mall, seeing lots of people in these crowded environments withimmediate increase in symptoms. More delayed reaction is seen withwatching television or reading.

Physical examination reveals an alert, cooperative, pleasant appearing11 year old female who is accompanied by her parents at time of consultand examination. The patient enters the examination room with a forwardhead carriage and hunched shoulders. She is fatigued quickly during thelong exam day and spends much of her time in a slouched posture.Physical examination is unchanged from her prior medical examination andwe focus first on functional evaluation. Neurological examination bothsensory and motor examination is unremarkable as stated in her priormedical records. During the course of the examination palpations of thesternoclavicular joints were quite painful, greater on the right.

Evaluation of the vestibular or balance system is performed utilizing aCDP Unit. The statistical norms are identified in the literature and thecomparison of stability scores are made to similar age and genderindividuals. The computerized posturography test identifies theprobability of the patient falling due to instability in the central orperipheral nervous systems. The score of 74% or better is the expectednormal score for an 11 year old female. The patient's scores were asfollows: Neutral head positioning reveals a stability score of 63% with28% fatigue ratio. Left head rotation 79% with 8% fatigability, righthead rotation 73% with 0% fatigue, neck flexion 66% with 0%fatigability, neck extension improved to 72% stability, 0% fatigability.

A pulse oximetry reading was taken. Asymmetry exists which varies withhead positioning, VOR activity with a dynamic range in excess of 5-15beats per minute at rest in neutral seated position. Videonystagmography revealed asymmetry in random saccadic activity, primarilyin velocity. No brain sequencing and timing assessment was performed dueto her fatigability.

Discussion: A right warm caloric stimulus resulted in a heart rate of 81BPM with no fluctuation in any labyrinthine positioning and was the mosteffective stimulation in stabilizing her dynamic range. This suggestsits application as an effective modality to increase and stabilize rightPonto-medullary function. Downward OKN and a Right Lower QuadrantinopialStimulation for 20 seconds improved her posturography scores to 72 and71% respectively in neutral position as well as lowering her BPM. Thissupports a diagnosis of right cerebellar/pontine dysfunction with lefthemispheric diaschisis. From the history, coincidentally, this is themother's reported site of impact. Prognosis is guarded.

Treatment: The patient was treated with the goal being to increase herparasympathetic output, stabilize her ponto-medullary (PM) system, andadditionally decrease the mesencephalic escape. The patient was given apair of red lenses to decrease the mesencephalic activation through hervisual system. The patient was given ear plugs to decrease the auditoryinput for the same purpose. Application of TENS unit in a right upperextremity montage was performed to increase parietalization of the leftcortex. Right VOR stimulation was performed very slowly with a max of180 degrees per session. Manipulation of right sternoclavicular joint,left ribs, and upper extremity was performed for afferentation of rightcerebellum. This treatment was recommended as a daily home assignment,with visitations at a frequency of 2-3 times per week for 6-8 weeks. Thepatient's metabolic rate was monitored throughout treatment and she wasre-examined weekly.

Two weeks later the patient returned with her mother for initialtreatment. The goal as explained was to begin to regulate the PM systemas identified by narrowing the 20-30 BPM swings in heart rate withalteration in head position while at rest or even, as has been evident,while at rest with head in neutral position. The treatment applied wasto the right cerebellum and Ponto-medullary system. The patient wastreated with: 1) Right VOR spin which is more tolerable and effectivewith fixation. 2) Manipulation of the right ribs. 3) Warm right caloricstimulus. 4) Red filtered lens. 5) Ear plugs. 6) Gyroscope for increasedcerebellar feedback. 7) Placing the right lower extremity in a bucket ofwarm water to increase small diameter afferent nerve feedback to PIVC.She tolerated treatment well, and remained between a 3.5 to 4.5 NPR. Shewas seen for 75 minutes in the morning and 60 minutes with intermittentbreaks in the afternoon.

The experimental treatment progressed with regular visitations. At eachsession, the patent received the same seven stimuli described above,tolerated the treatment well, and reported a consistent NPR of between3.5 and 4.5. The patient showed slow signs of improvement, mentioningthat her sleep had improved and appearing to be more upbeat, lessfatigued, and more tolerant to ambient light in the clinic.

On the ninth visit, the patient returned for follow-up and was treatedrecumbently. She maintained her heart rate at 83-85 BPM throughout thesession with electric stimulation, temperature stimulation, labyrinthineactivity, and active and passive ranges of motion of the cervical spinewith only 1-2 point increases in BPM. She did not complain in recumbentposture with passive positioning of the head—only 2 mild reports of painduring active unassisted head repositioning. She again had less of areaction to pain during VOR which succeeded for 360 degrees. The patientcontinued to have daily bowel movements without Miralax. She maintainedthe same P/O2 for the lower extremities as upper and there was noturning purple of the lower extremities as the autonomic challenge ofice application was successful. The experimental treatment was appliedwith the patient in the recumbent position, and the patient tolerated itwell, remaining between a 3.5 to 4.5 NPR.

The next day, the patient returned and noted that she had taken it easyover the weekend and felt the same reported NPR 3 to the neck and 4 tothe headache, however the ride was more tolerable as she was half waythrough her commute before she felt the ill effects of the car ride aswell as light sensitivity as it was a very bright day. When asked if shenoticed any decrease in light or sound sensitivity she replied “notreally” or “I do not know” but then realized she tolerated the car rideinvolving the two components that are disturbing to her. She had manyquestions regarding the improved autonomic outcomes which aredemonstrated by her no longer requiring Miralax to have a bowelmovement, whereas since infancy she would be 3-4 days constipated andrequire the laxative. Additionally the minimal if not absentdiscoloration of the lower extremities, even when challenged with icepacks, is quite impressive as compared to the initial visit. Thescheduled treatment was performed with the patient supine, and the heartrate was at 81 BPM supine with no fluctuation on labyrinthine activityor VOR spin.

The patient returned the next day with mom for follow-up treatment. Thepatient was ebullient and quite happy. She claimed her head pain was a3.5 and her neck pain was a 3. She had a resting heart rate of 85 BPMseated, 81 BPM supine. The heart rate did not fluctuate with headmovement supine and only 1-2 beats seated. Treatment in the morningsession consisted of SOT technique, TENS application, activator to C1,occiput and C2 on the right. Post treatment recheck in seated postureshowed her heart rate was 76-80 BPM with increased VOR activity to 2turns without change in BPM and no reporting of headache. Resistance tomuscle testing produced no change in BPM supine in either extremity.Once the observation of improvement was made the patient changed herdisposition, although less so than prior week's reaction and notedheadache after the progress is pointed out. Also, turning on thefluorescent light did not cause a spike in BPM and was tolerablealthough accompanied by squinting.

The patient returned the next day. Treatment was the same, except thewarm right caloric stimulus was replaced by left cortical efferentactivities (i.e., performing a subtraction) and the warm water immersionwas replaced by TENS application to increate parietalization. Thepatient tolerated treatment well in this session and the following one.

Six days later, the patient returned and noted improvement from lastvisit as she was more cheerful, and did not complain as much in terms ofdiscomfort to palpation, movement of the cervical spine, or increasedstimulation. She tolerated progressively faster VOR activity andcompleted three revolutions without discomfort but noted pressurebuilding on the initiation of the fourth. She mounted and dismounted thetreatment table in a prone and supine position which required she extendthe cervical spine which she did pain-free. When queried she indicatedclearly that there is pain “only sometimes”, in extension at the endrange of motion. She claimed and acknowledged that rotation and flexionare not painful. The patient added interactive metronome training to theregimen.

Two visits later, the patient returned from riding the escalator at theairport in an attempt to stabilize otolithic activity, and we identifiedthat downward translation is causing the mesencephalic escape. She wasable to climb and descend the escalator well twice without complaint,fatigue, or apparent discomfort with application of TENS on the right.The treatment added pictures to subtraction as a left cortical efferentactivity, and eliminated the use of TENS.

Three days later, the patient reported a breakthrough weekend where shewas able to visit a mall 12 miles away and ride the escalator severaltimes and walk a great distance successfully. The escalator ride wassuccessful while applying the TENS unit on the right hand side—thismitigated the pain and headache. The patient's father and motherreported she had a greater amount of energy and better disposition overthe weekend.

On the twentieth visit, the patient reported completing a successfulevening dining out that included significant multimodal stimulation thatshe previously was unable to complete, even with severe humidity andweather conditions affecting the vestibular system. The patient managedthe evening dinner which included conversation and ambient noisedemonstrating increased toleration in her auditory and visual processingabilities and metabolic capacity. The patient reported good energy andinteraction throughout. The morning session was increased to 90 minutesof treatment, while the afternoon session remained at 60 minutes withintermittent breaks. This pattern remained throughout the remainder ofthe therapy.

Over the next several visits, the patient was able to ride escalatorswithout TENS application, add to the number of therapeutic repetitionsshe was able to perform with improving fatigability, make significantgains in endurance and level of activity (both physical and cognitive),and cautiously incorporate pre-injury functions. Subsequently, thepatient was able to drive to the clinic without TENS application, andperform home activities with less fatigue. The mother felt that therewere flashes of the old (patient) returning in both activity anddisposition.

On the twenty-sixth visit, the patient reported headache bitemporallyand occasionally frontal with transient neck discomfort and milder lightsensitivity than previously. These residual symptoms did not increase,however, and there had been a significant increase in her physical andcognitive activities, in addition to other gains.

At this time, in comparison to the initial evaluation:

1) Dysautonomia is considerably improved as she no longer hasdiscoloration of the lower extremities even with temperature challenge.There is minimal discoloration around the nail beds of the large toeoccasionally on inspection after temperature challenge.

2) The patient no longer experiences “hot” episodes with no sweating.

3) For the past several weeks, the dynamic range of her pulse oximetryhas remained around 80 BPM with acceptable fluctuation of 1-3 BPM withlabyrinthine activity, cervical motion or VOR activity suggestingstabilization of the VOR mechanism and the related brain stem functions.

4) There is improved GI function as she is no longer dependent onMiralax and is having daily bowel movements.

5) Additionally, the mother notes that the fatigability from rehabsessions and homework activities is markedly less draining and the timeto recovery is noticeably shorter.

6) Her reading capacity has increased to 45 minutes to date. The patientis also watching television for periods of 30 minutes 3 times per day(with normal volume setting) with no adverse reaction.

7) She is able to successfully negotiate elevators, escalators andmoving walkways with greater stability and endurance. We identified thedeficit in the downward translational vector which produced asignificant headache on initial attempt and she is now able tosuccessfully perform 20 consecutive repetitions. This differentiates theutricular/saccular from canal components of the right cerebellardeficit.

8) The patient is capable of withstanding the 1 hour drive with partialuse of a TENS which we are phasing out this week.

9) The patient is demonstrating decreased auditory sensitivity as thevolume setting on the sequencing and timing equipment has progressivelybeen raised to near 50% max volume. This was done progressively withoutpatient complaint. This translated into the patient being able totolerate social activity over the past 2 weeks progressing to dinner outwith family and trips to the mall in the continued rehab protocol.

10) The patient no longer has sterno-clavicular pain and there iscomplete ROM of the cervical spine. Her identified area of tenderness nolonger involves the occipital area primarily but the mid cervical spineas she has less of a forward head carriage and is developing moreappropriate cervical biomechanics. Palpation is more tolerable.

11) The patient has improved disposition as the mother notes her oldpersonality is returning.

12) Finally, the patient is now sleeping through the night and themother is inquiring if and when her medication may be titrated down.

On the twenty-seventh visit, the patient willingly removed her redfiltered glasses during portions of the interactive metronome training.By the thirty-second visit, the patient willingly removed her red-tintedglasses for all tasks. The therapy assistant has been noting that thepatient has a sunny disposition. By the thirty-fifth visit, the patientno longer asks that the lights be turned off during varioustasks/manipulations. By the thirty-seventh visit, the patient appearshappier and does not complain of headaches or alternate pain.

On the thirty-ninth visit, the patient, her mother spent an hour in theparking lot waiting. Throughout that time, the patient was not sensitiveto either the bright sunlight or relative heat. The treatment concludedafter 43 visits, with the patient cheerful and talkative during the lastseveral sessions.

Proposed Explanation

A proposed explanation for the success of the methods described in thisapplication is as follows.

Examination of any patient should begin with an evaluation of theautonomic nervous system. The autonomic nervous system (ANS) is thefoundational tenant and prerequisite for basic life functioning.Contained within the central and peripheral nervous systems, the ANSdelivers fuel to both the brain and the body and modulates thefunctional interaction between these two systems. The ANS also acts as amediator between the environment and the internal organism, reacting toexternal stimulation with vital processes that are typicallyhomeostatic. These involuntary physiological responses and associatedinternal changes are a part of the body's behavior that is structured,where possible, to achieve a healthy physiology. For example, when anarea of the nervous system or brain is stimulated, a physiologicalresponse is elicited. If the autonomic response is congruent withexpected neurophysiology, the system is deemed intact. Conversely, ifthe stimulation elicits an aberrant physiological response, the aberrantresponse may be indicative of a pathological dysregulation. Examiningautonomic regulation in this manner allows a clinician to identify theprobability and/or existence of dysfunction, injury, or disease withinthe nervous system or body. However, until the methods presented in thisapplication, an evaluative approach as described herein has not been thestarting point of rehabilitative services.

Since the greatest probability for a patient's recuperative successdepends directly upon the functioning of her autonomic nervous system,Cortical Integrative Therapy (CIT), in accordance with the methods ofthe present invention, begins as a diagnostic process with anexamination of the ANS. By utilizing the physiological windows ofobservation, CIT clinicians determine the stability or instability of apatient's autonomic nervous system. Windows of physiological measurementfor use in determining response to ANS stimulation in accordanceherewith include heart rate, blood pressure, pseudo motor activity,oxygenation, sweating, and peripheral angiography. Pulse-oximetry is astandardized procedure for monitoring heart rate and oxygen saturationof normal and dynamic neurophysiology. Statistical norms in restingphysiology and physiological change/challenge are also understood asindicators of autonomic stability. The CIT clinician links thesymptom(s) back to the loss of normal neuro-physiology withconsideration to the specific inhibitory mechanism(s) and/or excitatorymechanism(s) or the balance of inhibitory and excitatory mechanismswhich permit the dysfunction.

One possible conceptual framework for rehabilitation in accordance withthe methods described herein may be found in the emergent concept of Dr.Antonio Damasio's brain-body maps. See, for example: Damasio, Antonio R.Looking for Spinoza: Joy, Sorrow, and the Feeling Brain (Harcourt,2003); Damasio, Antonio R. Descartes' Error: Emotion, Reason, and theHuman Brain (Penguin, 2005); and Damasio, Antonio R. et al., “Mindingthe Body”. Daedalus 135.3 (2006): 15-22. Another possible framework isprovided by Dr. Rodolfo Llinás and his brain timing mechanisms. See, forexample: Llinás, Rodolfo et al., The Mind-Brain Continuum: SensoryProcesses (Bradford Books, 1996); Llinás, Rodolfo (1998). “The neuronalbasis for consciousness”. Phil. Tran. R. Soc. Lond. (The Royal Society)353: 1841-1849; Llinas, Rodolfo (1999). “Thalamocortical dysrhythmia: aneurological and neuropsychaitric syndrome characterized bymagnetoencephalography”. PNAS 96 (26): 15222-15227; Llinás, Rodolfo R. Iof the Vortex: From Neurons to Self (MIT Press, 2001); Llinás, Rodolfo(2002). “Temporal binding via coincidence detection of specific andnonspecific thalamocortical inputs: A voltage-dependent dye-imagingstudy in mouse brain slices”. PNAS (The National Academy of Sciences) 99(1): 449-454; see also Jones, Edward G. “Thalamocortical dysrhythmia andchronic pain”. Pain (Elsevier) 150: 4-5. 2010 and citations therein.Understanding of the phenomenon of coherence may also informunderstanding of the underlying mechanisms. The articles cited in thisparagraph are incorporated by reference as if set forth in theirentirety herein.

Consistent with the methods described in this application, importantstages of Cortical Integrative Therapy (CIT) include the following:

Stage 1: Stabilize autonomics;

Stage 2: Build metabolic capacity within the ANS;

Stage 3: Build adaptive plasticity in the injured or compromised system;and

Stage 4: Reintegration strategy into other rehabilitative modalities.

Stage 4 is the implementation of specific strategies to restore ANSperformance as closely as practicable to norms associated with healthyphysiology as understood by present day neuroscience. As cited above,Dr. Rodolfo Llinás, MD, PhD, has shown that many of the higher brainfunctions, including consciousness, are products of the timing of theconstant oscillations that exist between the thalamus and the rest ofthe brain. This is a loop of signals from the thalamus to corticalregions and a return of signals from the various sensory processingareas of the brain. Higher functions, including consciousness, existwhen these oscillations are synchronized. This allows the processingcenters of the brain to assemble the disparate intrinsic and extrinsicdata into a cohesive whole, a process known as temporal binding.

The frequencies of the oscillations are dependent on the state of brainactivity including mental activity. This central state is regulated bythe thalamus' gating activity on the sensory information that reachesthe cortex as well as the thalamus' own feedback control of the loops tosaid cortices. Thalamic neurons that are typically involved with thisprocess are: thalamo-cortical, thalamo-reticular, and thalamicinterneurons.

The oscillatory feedback process begins in oscillatory cells within thethalamus, which have input from somatosensory pathways and feedbackpathways that are intrinsic to the brain. These thalamic oscillatorycells are highly responsive, and change accordingly to the dynamicnature of the inputs they receive. The greatest modulation of thesefeedback loops is from inhibitory interneurons that are within thethalamic reticular nucleus and the cortex. Also, when a particularregion of the cortex is involved in a thalamocortical feedback loop,which appears to be columnar in nature, the adjacent columnar areas areactively inhibited. This has the effect of physically separatingoscillation resonance pathways from each other. Multiple thalamocorticalloops are able to occur simultaneously throughout many different regionsof the brain during conscious activity. The synchronization of theseoscillations between the different regions of the brain allow forcohesive functioning that is associated with specific brain activities,mental states, and consciousness. When these oscillatory feedbackprocesses are not properly synchronized a strong association has beenshown with cognitive disorders, neuropathic pain, tinnitus, Tourette's,as well as Parkinson's disease. CIT creates a starting point andmonitoring strategy to ensure the optimal rehabilitative outcomes.

The embodiments of the invention described above are intended to bemerely exemplary; numerous variations and modifications will be apparentto those skilled in the art. All such variations and modifications areintended to be within the scope of the present invention as defined inany appended claims.

What is claimed is:
 1. A method of treating a subject havingpost-concussion syndrome (PCS), the method providing a protocolcomprising: identifying post-concussion syndrome in the subject;selecting a plurality of distinct postures, to be sequentially assumedby the subject, from a posture set of walking, standing, sitting, andsupine; selecting a plurality of distinct stimuli, to which the subjectwill be sequentially subjected, from a stimulus set of TENS, non-painfulheat, non-painful cold, visual, occulomotor stimulation, crude touch,olfactory stimulation, vestibular stimulation, and auditory stimulation;selecting an autonomic physiological response parameter, to bequantitatively measured as of when the subject is subjected to eachselected stimulus, from the response parameter set of oxygen saturation,heart rate, pupillary response, blood pressure, sweat production,pseudomotor activity, and respiration; having the subject sequentiallyassume each selected posture; in each of the selected postures,subjecting the subject to each of the selected stimuli sequentially,quantitatively measuring the selected autonomic physiological responseparameter as of when the subject has been subjected to each of theselected stimuli, and recording each of the quantitative measures inassociation with the corresponding posture and stimulus; analyzing therecorded quantitative measures to identify the posture with respect towhich the subject exhibits a least amount of dysfunction relative to astatistical norm, and identify the stimulus with respect to which thesubject exhibits a least amount of dysfunction relative to thestatistical norm when in the identified posture; repeatedly: subjectingthe subject to the identified stimulus while the subject is in theidentified posture and while using an instrument to provide aquantitative measure of the selected autonomic physiological responseparameter as of each instance when the subject has been subjected to theidentified stimulus, and recording each of the quantitative measuresrelating to each such instance, until the recorded quantitative measuresindicate that a desired endpoint physiological condition has beenachieved approaching normalcy relative to the statistical norm; uponachievement of the desired endpoint physiological condition, having thesubject assume a posture different from the identified posture, and,when the subject is in such posture, subjecting the subject to one ofthe selected stimuli while using the instrument to provide aquantitative measure of the selected autonomic physiological responseparameter and recording the quantitative measure for the differentposture; analyzing the recorded quantitative measure for the differentposture to determine whether there is a dysfunction in response of thesubject, relative to a further statistical norm, to the one of theselected stimuli; and upon existence of such a dysfunction, repeatedlysubjecting the subject to the one of the selected stimuli at thedifferent posture until a further desired endpoint physiologicalcondition is achieved approaching normalcy relative to the furtherstatistical norm, wherein the post-concussion syndrome is associatedwith at least one symptom selected from the group consisting ofheadaches, dizziness, neck pain, stiff neck, cold sweats, excessive eyesensitivity to light and combinations thereof, the treatment resultingin a decrease in the at least one symptom, and wherein the foregoingprotocol promotes thalamocortical pathways within the brain.
 2. Themethod according to claim 1, wherein subjecting the subject sequentiallyto each of the selected stimuli includes, for each selected stimulus,varying at least one parameter of the stimulus, the parameter selectedfrom the group consisting of amplitude, frequency, and duration of thestimulus, and wherein analyzing the recorded quantitative measures toidentify the stimulus with respect to which the subject exhibits a leastamount of dysfunction when in the identified posture further includesidentifying a parameter value, associated with the at least oneparameter of the stimulus, with respect to which the subject exhibits aleast amount of dysfunction relative to the statistical norm.
 3. Themethod according to claim 1, wherein the desired endpoint physiologicalcondition is a condition wherein subjecting the subject to a stimulusfrom the stimulus group, other than the identified stimulus, does notcause dysfunction in the subject while the subject is in the identifiedposture.
 4. The method according to claim 1, wherein if no dysfunctionin the subject exists while the subject is in the at least one posturedifferent from the identified posture, the method further comprises:performing additional therapeutic modalities to facilitate furtherenhancement of physiological condition.
 5. The method according to claim1, wherein measuring an autonomic physiological response parameter as ofwhen the subject has been subjected to each of the selected stimuliincludes performing at least one measurement selected from the groupconsisting of Video Electronystagmography, pulse oximetry, ComputerizedDynamic Posturography and combinations thereof.